Healthcare Provider Details

I. General information

NPI: 1417205949
Provider Name (Legal Business Name): DANA THERESA BAGEON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WAYZATA BLVD E STE 120
WAYZATA MN
55391-1984
US

IV. Provider business mailing address

1120 WAYZATA BLVD E STE 120
WAYZATA MN
55391-1984
US

V. Phone/Fax

Practice location:
  • Phone: 952-443-4600
  • Fax: 952-456-6633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12744
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9200809
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014513
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170958
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001508
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18099
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: